Quality overall before the pandemic

The care that people receive in England is mostly of good quality.

As at 31 March 2020:

• 80% of adult social care services were rated as good and 5% as outstanding (31 July 2019: 80%, 4%)
• 89% of GP practices were rated as good and 5% as outstanding (31 July 2019: 90%, 5%)
• 67% of NHS acute core services were rated as good and 8% as outstanding (31 July 2019: 65%, 7%)
• 71% of NHS mental health core services were rated as good and 11% as outstanding (31 July 2019: 71%, 10%)

While it is clear that care providers were able to maintain the quality of care they provided, it is also clear that there was by and large no improvement overall.

However, this overall picture does mask the improvement and deterioration that happens at a service level. For example, in the year to 31 March 2020, 192 GP practices improved their rating to good on re-inspection and 173 declined from a rating of good.

There was some improvement in NHS acute care, where 75% of core services were rated as good or outstanding compared with 72% the previous year. Looking at our individual key questions ratings, the proportion rated as good for safety rose from 61% to 63%, and for well-led from 68% to 70%.

But there are still services where the quality of care needs to improve substantially – more than half of urgent and emergency care services were rated as requires improvement or inadequate as at 31 March 2020, as were almost a third of medical care and outpatient services. A quarter of maternity services were rated as requires improvement.

We were pleased to see an improvement in community health care ratings, with 75% of all core services rated as good and 12% rated as outstanding at 31 March 2020, compared with 74% and 10% in 2019.

However, among mental health services, we continued to find more poor care in inpatient wards for people with a learning disability and/or autistic people. The overall proportion of services rated as inadequate rose from 4% to 13%. Almost all of this happened in independent services, where the proportion of services rated as inadequate rose from 5% to 22%; in contrast, NHS services rated as inadequate remained at 3% of the total.

There are 10 NHS ambulance trusts in England, of which one was rated as outstanding, eight as good and one as requires improvement as at 31 March 2020.

We continue to have some significant concerns about independent ambulance services, following our 2019 report on the sector. Having been given the powers to rate independent ambulance services, we began a second round of inspections. As at 31 March 2020, 11% of 101 services were rated as inadequate and 33% as requires improvement. While there are clearly good services in the sector, these ratings highlight our ongoing serious concerns, particularly about safe recruitment and safeguarding practices. As a result, we have taken a significant amount of enforcement action.

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Care that is harder to plan for was of poorer quality

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Part 1: Quality of care before the pandemic